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23.10.2019 | Adenokarzinom des ösophagogastralen Übergangs | Leitthema

Pathophysiologie des Adenokarzinoms am ösophagogastralen Übergang (AEG)

verfasst von: Dott. L. Liotta, PD Dr. med. M. Quante

Erschienen in: Die Onkologie | Ausgabe 12/2019

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Zusammenfassung

Hintergrund

Der Barrett-Ösophagus wird als entscheidende Ursprungsläsion für das Adenokarzinom am ösophagogastralen Übergang (AEG) angesehen.
Weitgehend unklar ist allerdings nach wie vor, welche Faktoren, Einwirkungen und Abläufe für die Karzinogenese verantwortlich sind.

Fragestellung

In dieser Übersichtsarbeit sollen v. a. die Bedeutung epidemiologischer, genetischer und immunologischer Faktoren sowie der Einfluss eines hierdurch teilweise veränderten Mikromilieus als initiierende Faktoren erörtert werden.

Ergebnisse

Veränderungen in Mikrobiom und Genstruktur (z. B. durch Verlust von TP53 und p16) können eine Nische von Stammzellen am ösophagogastralen Übergang (die z. B. in Mäusen LGR5, CCK2R und CAR4 exprimieren) bilden, in der vermehrte Zellteilung sowie eine maligne Entartung begünstigt wird. Dabei könnten spezifische Stammzellen, die wahrscheinlich aus Drüsen im Bereich der Kardia im Magen entstehen − als Ursprung für die maligne Transformation sowie in Abhängigkeit von ihrem Differenzierungspotenzial für die Tumorentstehung ausschlaggebend sein. Aktuelle Studien deuten darauf hin, dass das metaplastische Epithel nicht im Ösophagus, sondern in der Kardia entsteht, von wo Stammzellen (im weiteren Verlauf) in den Ösophagus expandieren.

Schlussfolgerungen

Ein besseres Verständnis dieser Mechanismen kann zu einer besseren Früherkennung, Prävention und schlussendlich auch Therapie der AEG führen.
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Metadaten
Titel
Pathophysiologie des Adenokarzinoms am ösophagogastralen Übergang (AEG)
verfasst von
Dott. L. Liotta
PD Dr. med. M. Quante
Publikationsdatum
23.10.2019
Verlag
Springer Medizin
Erschienen in
Die Onkologie / Ausgabe 12/2019
Print ISSN: 2731-7226
Elektronische ISSN: 2731-7234
DOI
https://doi.org/10.1007/s00761-019-00666-9

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